Saturday, February 6, 2016

Will lockout lead to more NHL injuries?

Some hockey players are working out on their own. Others are playing in Europe. None are at training camp, and that has one of the Flyers' physicians concerned.

Will lockout lead to more NHL injuries?

Philadelphia Flyers goalie prospect Niko Hovinen, lef of Finland, and Danny Briere take a break during an informal hockey practice at the team´s training facility, Thursday, Sept. 20, 2012, in Voorhees, N.J. The league locked out its players this month, its fourth shutdown since 1992. (AP Photo/Tom Mihalek)
Philadelphia Flyers goalie prospect Niko Hovinen, lef of Finland, and Danny Briere take a break during an informal hockey practice at the team's training facility, Thursday, Sept. 20, 2012, in Voorhees, N.J. The league locked out its players this month, its fourth shutdown since 1992. (AP Photo/Tom Mihalek)

by Peter F. DeLuca, M.D.

Ah, October, one of my favorite months. Crisp fall weather is here, football is in full swing, the Major League Baseball playoffs and World Series are upon us and the start of the basketball and hockey seasons have finally arrived. What more can an avid sports fan ask for?

Oh wait! The NHL is in a lockout with no obvious settlement in sight.

It was just a year ago when the NFL went through a similar Lockout. The players missed the mandatory workouts at the team facilities, minicamps and OTAs (Organized Team Activities). When they were finally able to practice with their teams, we saw an increase in muscle strains and tears because the athletes did not train according to a normal NFL regimen. Will we see the same in the NHL?

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One difference between the NHL and the NFL Lockouts is that NHL players have the opportunity to play hockey in Europe or for NHL affiliate teams, (AHL, ECHL). There is no such system in the NFL. This allows the athletes to maintain their aerobic conditioning while getting into “hockey shape”. These players who play in other leagues expose themselves to injuries that may have an impact on their teams once the lockout is settled. However, NHL team physicians cannot treat these injured athletes during the Lockout.

As the head orthopedic surgeon for the Philadelphia Flyers, I have to read various Web sites to hear about injuries sustained by Flyers who are playing in Europe. Although I am concerned about these players, I am also concerned about the players who have elected not to play in other leagues. A player can go to the gym daily and workout every different muscle group, improve their aerobic conditioning and eat a balanced diet, all of which are very important in preventing injuries. But nothing a player does in the gym can recreate the forces that he experiences on the ice, which is called “hockey shape”.

Those forces that the player experiences during pre-season and in the early regular season further condition muscles to lessen major injuries later in the season.

So, what am I worried about?

In hockey, the most common muscle injury is to the adductor or groin tendon. Studies have shown that players who ice skate or roller blade in the off-season will demonstrate a decreased risk of groin strains. It’s that increased intensity of skating that the player performs in a game situation that further strengthens and conditions that adductor muscle. I anticipate that we will see an increased incidence of groin strains in athletes that have not been playing hockey once the lockout ends.

I believe we also will see a higher incidence of concussions in those “inactive” players. Concussions will occur in any contact sport, and there is no way to absolutely prevent them from happening. Improved helmets, wearing a mouthpiece and rule changes will decrease the risk of sustaining a concussion.

However, there is probably a more important aspect that can decrease the incidence of concussions—strengthening of the neck muscles.

It is a misconception that a direct blow to the head causes a concussion. A concussion results when the brain, which is sitting in a liquid, rapidly moves and strikes the inner aspect of the skull. This occurs when the relaxed muscles of the neck allow the neck to snap back and forth which increases the shear force to the brain. Concussions occur more commonly when a player, moving at a high speed and not expecting to get hit, collides with another player or immovable object (Boards or Ice Surface) and the head whips from side-to-side.

The impact does not necessarily have to be to the head; more commonly it is to the upper body. During a mid-ice collision, a concussion occurs at the time of the body-to-body impact, not when the head hits the ice. Strengthening the neck (cervical) muscles can decrease the shear stress to the brain thereby decreasing the risk of sustaining a concussion. Have you ever noticed that the player who initiates the hit (even a helmet-to-helmet hit) very rarely sustains a concussion? That is because the initiator of the impact contracts his or her neck muscles, so faces little head movement.

Working out the cervical muscles not only can decrease concussions, but the low-intensity checks that occur during a normal hockey game condition the neck muscle to help absorb the impact. Those athletes not playing during the lockout will be at increased risk for sustaining a concussion.

Training camp, even though it’s exhaustive and painful, does help decrease injuries. Lockouts can work the other way. 

With that in mind, like all hockey fans, I cannot wait for the NHL to get back to playing.

Peter F. DeLuca, M.D. is an accomplished orthopaedic surgeon and sports medicine specialist. He is the head team physician for the Philadelphia Eagles and head orthopaedic surgeon for the Philadelphia Flyers. 

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